LAS VEGAS -- If drug therapy is required in pregnant patients with gastroesophageal reflux disease, first-line treatment should consist of non-systemically absorbed medications like antacids and sucralfate, Dr. Joel Richter said at the annual meeting of the American College of Gastroenterology.
Hardly any of the drugs used to treat gastroesophageal reflux disease (GERD) have been tested in pregnancy, said Dr. Richter, chairman and professor of gastroenterology at the Cleveland Clinic Foundation.
Systemic therapy with [H.sub.2] antagonists or prokinetic drugs like metoclopramide or cisapride should be reserved for patients with severe symptoms. "Metoclopramide does cross the placenta and is excreted in breast milk," he noted. "But there are no teratogenetic effects in animals or in humans. It may be a drug you want to use in the pregnant patient [who presents] with nausea and vomiting."
Ranitidine is one of the few drugs that has been documented to be effective in pregnancy, especially at dosages of 150 mg b.i.d. (Obstet. Gynecol. 90[1]:83-87, 1997). He cautioned against using the [H.sub.2] antagonist nizatidine, though. "With the little data we have on it, there does appear to be an increased rate of spontaneous abortions, congenital malformations, low fetal weight, and fewer live births, so I would recommend not using that [H.sub.2] blocker."
Dr. Richter considers using proton pump inhibitors (PPIs) in pregnant patients only after endoscopy and subsequent to failure to respond to [H.sub.2] antagonists and prokinetic drugs. "It's good to avoid drug therapy if you possibly can, but you always must have an honest discussion with the mother about the risk-versus-benefit ratio," he said. "I think treatment should depend on symptom severity and should involve a stepwise increment in the drug you use."
Animal studies show that omeprazole, but not lansoprazole, caused fetal toxicity at doses 17-172 times the doses typical used by humans. Yet isolated reports suggest that omeprazole is safe to use during all three trimesters of pregnancy.
COPYRIGHT 2002 International Medical News Group
COPYRIGHT 2002 Gale Group
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